Exploring the shards and colors of life

Respiratory Therapy

Graduating from “respiratory school” brought a great sense of accomplishment along with the reality that I was now required to live like a responsible adult. I was happy to be finished, but also had a nagging sense of dread: was this it? Was this all there was to my life? I was 21 years old by this point. Was this the zenith of my adulthood? Would there be anything else, or would I just work as a Respiratory Therapist and lead a boring, predictable life with few spurts of excitement?

Around the time of my graduation, the college from which I graduated began baccalaureate programs, including one in Respiratory. I decided that I would continue my education and obtain a bachelor’s degree. I thought this would solve my problem: I could still be in school while I worked, and this would give me a few more years to decide what was next in my life.

I was still working part time in the area’s Level 1 Trauma Center, but my hours had picked up considerably after I graduated. I hadn’t accepted a true full-time position there, but was essentially working full-time hours. I started picking up night-shift schedules also, which started at 6:30 pm and ended at 7:00 am the following morning. I was now a full-time student, working full-time hours at the hospital, often at night. I felt tired all of the time. But I was gaining valuable experiences along the way. In addition to all of this, I continued working in the Nuclear Medicine department on occasion to supplement my income.

At the end of September 1999, the stress of working full-time and going to school full-time took its toll, and after talking to a mentor, I dropped out of the baccalaureate program. That evening, while at work, the night shift supervisor asked me how school was going.

“I quit,” I answered. He gave me a curious look.

“You quit?” His face quickly brightened. “That means you can take a full-time position. We have one available in ICU,” he said.

I interviewed for the ICU position, and after I accepted the offer, they started me in ICU right away. There were at least three of us RTs who were responsible for three “pods” of ICU beds. There were about five or six patients in each pod. Pod A was where burn patients were placed.

I will never forget the night that “Curtis” came in. He was an African American man that was burned so badly, his beautiful brown skin was a patchwork of bloody pink and white. I no longer remember the percentage of his body that was burned, but it was high enough that his chances of survival were very slim. We worked to stabilize him; he was intubated and placed on a ventilator right away. Later, when his drug test results came back, we understood why he was burned so badly. He had been high on cocaine, and was smoking in bed. The mattress caught fire, and rather than evacuate, he tried to extinguish the burning mattress by taking it into the nearby bathroom. The mattress overpowered him, knocking him to the ground, and he sustained third-degree burns over much of his body.

When people say that you never forget the smell of burnt human flesh, it is true. To this day, I can smell this man’s burnt flesh as we worked to stabilize him. He lost fingers and toes, and had skin grafts all over his body. He sustained heat inhalation to his airways and lungs, causing them to fill with fluid and nearly drowning him. We had to use special modes of ventilation to overcome the stiffness in his lungs that prevented him from getting adequate oxygen. Statistically, he was a dead man. But he survived.

Curtis slowly improved, after many weeks of skin grafts and close calls with death. As he improved, he was able to spend several hours during the day without being on the ventilator, but then he was placed on it at night so that he could sleep and not struggle to breathe. By this point he’d had a tracheostomy for quite some time, which made these trial periods on and off the ventilator easier to accomplish.

One night Curtis and his Pod were my assignment for the evening. He was now having test trials of going all night long without the ventilator. He had a “cap” on his trach so that he could speak (normally patients with an open trach cannot speak because the trach is placed lower in the neck so that the air goes in and out below the vocal cords). He was getting ready for bed, and I was giving him his last breathing treatment of the evening. He had his television on, but it was tuned to a local rap radio station. All of a sudden, this song came on, and it was one of those songs that was popular at the time, Juvenile’s “Back that A** Up”. Curtis, without missing one beat, began singing and dancing from the waist up in his hospital bed. In a raspy voice, he sang, “Girl, you lookin’ good, won’t you back that thing up; you’se a big fine woman, won’t you back that thing up…” I couldn’t help laughing. This man had been on life support for at least two or three months, having survived several tangos with death, and here he was, singing along with this rap song and grooving to it like nothing ever happened.

Eventually he was moved to one of the step-down floors and I suppose he was eventually discharged home. I’ll never know what life was like for him after he left ICU.

There were two other patients whose memories remain with me, all these years later.

One young lady, 17-years old, was the driver of a car that crashed into and became pinned under a semi-truck. She was my patient one night, and I was in her room checking her ventilator. Just then, several male friends of hers came into her room and began singing hymns to her, in that way that only African Americans, who have tasted centuries of suffering, can sing. The boys’ voices blended in a tight harmony so rich with sound and solace that my eyes immediately swelled with tears, and I had to leave the room. I went into the one of the supply rooms and cried silently, trying to compose myself. I wasn’t that much older than this precious soul. To this day, I do not know what happened to her, but her injuries were severe enough that I am pretty sure she did not survive them.

And then there was the other patient. I think he was in his 40s. He was a very tall, thickly built man, with close to 300 pounds on his 6’5″ frame. He had been T-boned by another driver and sustained abdominal injuries so severe that after surgery, they could not close up his abdominal incision because of all the swelling. They put a special film over his incision to keep infection from setting in. His lungs also sustained a lot of trauma, and over a few days, they stiffened and wouldn’t allow the proper exchange of oxygen and carbon dioxide. We had to use special modes of ventilation to try to overcome this problem. Eventually, he was placed on a Stryker bed, which turns so that the patient is face down. The theory is, when a person is lying on their back, the blood pools at the lowest points of the body thanks to gravity. If a person is turned over and made “prone”, then the blood will move more easily to other areas of the body, and this will increase circulation and oxygenation.

We had to “prone” this man every 4-8 hours per doctor’s orders, and because of his large size, it often took eight or ten nurses and RTs to turn him. Also, because of his open abdominal incision, one of the RT supervisors brought in a tire inner tube to place under his abdomen so that his inner parts were not squished when he was prone. We worked so hard to save this man’s life, and he survived his injuries. What I will never forget is how mean this man was once he was finally healthy enough to come off of the ventilator. He was demanding and critical of the nurses who cared for him. This man had no idea how close to death he had come, and how hard and creatively we worked to save his life. He had not one ounce of gratitude for the care he had received.

No one was sad to see him discharged from the ICU.

My time working in the ICU also included the scare of Y2K, when everyone thought that the computer world would come to a screeching halt on January 1, 2000. I had to work in the ICU that New Year’s Eve. I remember it being a quiet night. We had several empty rooms in the three Pods. The patients who were on ventilators had Ambu bags on standby, and we RTs were ready to manually “bag” those patients if the ventilators suddenly shut down at midnight. It never happened, and the ventilators continued humming along.

I continued humming along for another four or five months, but the stress and worry got to me. I constantly went home wondering if I did everything right on my shift, going through each patient and my time with them to ensure I didn’t make any mistakes. Eventually I left my ICU position and worked at my Nuclear Medicine job a lot more as I was getting paid the same amount of money, and it was less stressful. By this point, I was also thinking of going back to school to pursue something different, getting away from Respiratory after a few short years. However, leaving my ICU job would not be the last of my Respiratory journey.

This was originally written in the summer of 2014, not long after returning to a job I had had previously.

It is 9 p.m. on a Tuesday evening. My feet ache from being in high-heels all day. My back hurts, reminding me that I am not completely healed from the February 2014 back injury that I sustained at work. Tomorrow is a bit of a homecoming. I’ve been here before. I fell right into the preparation routine, after being out of it for more than two years. I spent time after hours copying the PowerPoint handouts that we will need tomorrow, copying the other handouts that go along with the presentation that I will give, putting the props on the table just like I did more than two years ago when I worked for this Company. Tomorrow will be the first time in over two years since I last taught this class, and tonight’s prep work felt so natural that I kept asking myself it had truly been two years since I was here.

Earlier in the day, when I introduced myself to my students who came to learn how our Company does business, I told them that I had been a licensed Respiratory Therapist for 16 years. I did not know I was old enough to be or have done ANYTHING for that long. In some ways I still feel like I am in my early 20s (except for the lingering effects of the back injury). I stood there in my high heels, asking myself incredulously, “Has it really been that long?” And the answer is yes. It has been a kaleidoscopic journey, one that, for some reason, I feel compelled to share.

I rarely discuss my work with anyone, because when people ask about my occupation, I receive looks of confusion or I am assumed to be a Physical Therapist or a nurse. I am neither. I am a credentialed Respiratory Therapist, currently licensed in three states. Here is how my journey began.

An Unlikely Occupation

It must have been sometime in early 1996, the year I graduated high school. I attended a small boarding academy in central Ohio, and I suspect my guidance counselor was concerned about my future. I was an average student, but I was too distracted by boyfriends and didn’t think much about the future. My guidance counselor talked to me one day about my plans after high school. Most of the kids in my class had already mapped out their college or university plans. I don’t remember doing much college planning with my parents.

This may explain why my guidance counselor had this little talk with me – perhaps she feared that I would fall through the cracks and never get anywhere. She told me about a college in southwest Ohio, with programs in Nursing, Radiology Technology and Respiratory Therapy. “You have asthma,” she reasoned with me. “You could relate really well with the patients. It’s a two-year degree so you can start working fairly quickly.” Those weren’t her exact words, but I remembered almost mindlessly agreeing, “Okay, that sounds good.” That summer after graduation, I prepared myself for a new life as a college student, not sure at all what to expect. I remember being worried, because I had always seen myself as an artistic person and as I looked at the requirements for the Respiratory program, with its science and biology prerequisites, I began to think maybe this was not a good idea after all. Later that summer, I discovered that my best friend from high school was also going to this college, also in the Respiratory Therapy program. Somehow that put me at ease; she was much more outgoing than I, and her presence would help me make friends easier. My unlikely journey to college began that August in 1996.

In August 1996 I became a college student at a medical arts college in southwest Ohio, and for the next year I took general courses before I was officially accepted into the Respiratory Therapy program in 1997. Each week we attended classes as well as twice-weekly “clinicals”, which were rotations at various local hospitals to gain real-life experience under the tutelage of Respiratory Therapist preceptors. Our clinical time was spent performing breathing treatments, breathing exercises, chest percussion treatments (to help loosen mucus and clear it from the airways), and later, as we advanced in the program, we learned about mechanical ventilation. Whenever you hear someone saying “They’re on life support”, Respiratory Therapists are usually the ones who are managing the “life support” (aka ventilator).

Once we began our Clinical rotations with mechanical ventilators, the severity of illnesses that we encountered definitely escalated. I came into contact with patients and their families who relied heavily on the work that Respiratory Therapists do, and I believe that is when I began to understand the importance of my new occupation. I also began to realize that RTs do not serve one age demographic, a point that was brought close to home one day as I cared for a young man who was my age. He was on a ventilator, and we were utilizing modes of therapy that were not typical, because he was not responding to conventional therapy. I no longer remember what was wrong with him, but I was quite saddened when he passed away, and especially when I learned that his parents had previously lost another son.

In 1998 I was permitted to obtain a limited license to practice Respiratory Care as a student. I began working at the area’s Level 1 Trauma Center, and although they gave me mostly breathing treatments to do during my shifts, I still had opportunities to spend time with my shift managers in the Emergency Room seeing some incredible situations. I will never forget seeing a woman who was badly injured in a car crash, to the point where they had to split her chest open because her aorta was torn and she literally bled completely into her abdominal cavity. As the other medical staff tried hard to resuscitate her, my supervisor and I performed artificial breathing through a tube which was inserted into her trachea (windpipe), using a balloon-like Ambu-bag that we squeezed intermittently to push air into her lungs. Because her chest was split open, I could literally see her left lung expanding as we ventilated her. Obviously I felt very sorry for her and did not want her to suffer just so I could see a real-life lung in action. But this wouldn’t be the last time I had encountered horrible situations. Perhaps this is one of the things that people don’t understand about Respiratory Therapists: we are often on the “front lines” of emergency situations in the hospital setting.

Graduation came in 1999, and the last requirement of my program involved spending five weeks at a hospital to complete a Clinical Practicum. My Respiratory Therapy program had a relationship with Florida Hospital in Orlando, and I was one of two students selected to go there for the practicum. Again, because of the location and the demographic there, I had the opportunity to experience situations that I had not seen or experienced previously. After my five weeks in Florida, I returned home to Ohio and a short while later, I sat for my first exam to became a Respiratory Care Practitioner, a Certified Respiratory Therapist (CRT). Later in December, I sat again for another exam and passed, becoming a Registered Respiratory Therapist. By this point, I had secured a full-time job as an RT in the Critical Care Department of the Level 1 Trauma Center where I had worked as a student.

The sheltered student life was over.

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